Build the infrastructure of independent managed care.
MSO Inc. has run delegated claims, credentialing, utilization management, and provider operations for IPAs and medical groups since 1999.
Current Openings
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Lead claims operations for delegated IPA and medical group clients. Oversee adjudication workflows, vendor coordination, and compliance reporting.
Role Overview
MSO, Inc. of Southern California, a management services organization serving Independent Physician Associations and medical groups across California and Texas since 2001, is seeking an experienced Claims Manager to lead our Claims Department.
This position is responsible for the supervision, direction, and monitoring of claims operations, ensuring accurate and timely claims adjudication in accordance with provider contracts, Health Plan requirements, and regulatory standards for Medi-Cal, Medicare, and Commercial lines of business.
This is a remote position. Candidates must reside in California, with Southern California residency preferred for occasional on-site meetings at our Costa Mesa office. Salary range: $90,000 to $110,000 annually. Reports to the President/CEO.
Key Responsibilities
- Oversee day-to-day workflow of the Claims Department, including supervision, training, and development of claims staff
- Ensure timely, accurate claims adjudication and payment, including correct interest calculations, in compliance with regulatory and Health Plan standards
- Prepare and submit Claims Timeliness Reports and other required Health Plan reporting with organized proof of submission
- Manage provider and Health Plan appeals and oversee timely, accurate payment recovery
- Coordinate claims audits and corrective action plans with Health Plans, auditors, and providers
- Develop and maintain department policies, procedures, and process improvement initiatives
- Create reports to track and trend staff performance and identify training opportunities
- Support electronic claims submission integration, system upgrades, and auto-adjudication improvements
- Collaborate with Provider Services on provider, vendor, and contract data maintenance
- Keep executive leadership and clients informed on processing status, backlog, refunds, and unresolved issues
Qualifications
- Minimum five (5) years of medical claims adjudication experience, preferably in managed healthcare
- Minimum three (3) years of supervisory experience with strong leadership and managerial skills
- Experience processing both Professional and Technical/Facility claims
- Expertise in ICD, CPT, and HCPCS coding; understanding of APR-DRG, DRG, LTC PPS, and SNF PPS methodologies
- Strong knowledge of DHCS, DMHC, CMS, and Health Plan regulations and reporting requirements for Medi-Cal, Medicare, and Commercial claims
- Definitive understanding of provider and Health Plan contracting, delineation of risk, medical terminology, and standard industry reimbursement methodologies
- Familiarity with IPA/Medical Group benefits and contracts
- Proficient computer skills; strong Excel skills preferred
- Excellent verbal and written communication, analytical, organizational, and problem-solving skills
- Ability to work independently with limited supervision; detail oriented and team focused
- High school diploma required; some college preferred
- Claims audit and training/presentation experience preferred
Location and Work Arrangement
This position is remote. Southern California residents are preferred, as occasional on-site meetings will be held at our corporate office in Costa Mesa, California.
How to Apply
Submit your resume to MSO, Inc. of Southern California, 3330 Harbor Blvd, Suite 200, Costa Mesa, California 92626, or email lanphan@msosocal.com with the subject line "Claims Manager Application."
Process professional and institutional claims, validate authorizations, and support provider and member inquiries in a fast-paced managed care environment.
Role Overview
MSO, Inc. of Southern California is a management services organization serving Independent Physician Associations and medical groups across California and Texas since 2001. We administer Medi-Cal, Medicare Advantage, and commercial lines of business, providing claims, utilization management, credentialing, compliance, and contracting services to our client IPAs.
The Claims Examiner I is responsible for the accurate and timely adjudication of professional and institutional claims across Medi-Cal, Medicare, and commercial lines of business. This position determines payment and denial status, prepares claims for payment, and performs limited contract interpretation. The Claims Examiner I must be highly organized, detail oriented, and able to manage time efficiently in a production environment. Other duties may be assigned as directed by the Claims Supervisor or Claims Manager.
Location: Remote (Southern California residents preferred due to occasional onsite meetings at our Costa Mesa, California office). Pay range: $24.00 to $30.00 per hour (commensurate with experience).
Responsibilities and Duties
- Process inpatient and outpatient hospital claims (UB-04) and professional claims (CMS-1500/HCFA 1500)
- Perform claims adjudication, coding review, and coverage determinations
- Interpret provider contracts and contract rates for Medicare, Medi-Cal, and commercial lines of business
- Process and adjudicate refunds, reimbursements, appeals, and grievances
- Verify member eligibility, effective dates, and coordination of benefits (COB) with primary insurance
- Apply regulatory timeliness standards, including guidelines for processing 30-day, 60-day, and denied claims
- Develop and generate provider correspondence and denial letters
- Maintain claims department production quotas and quality standards
- Apply knowledge of AB134 and applicable California claims settlement requirements
Education and Experience Requirements
- Two to three years of experience processing managed care claims
- Experience processing all lines of business: Medicare, Medi-Cal, and commercial
- Knowledge of CPT, HCPCS, and ICD-10 coding, and proficiency in RBRVS pricing methodologies
- Knowledge of medical terminology
- Computer literate with working knowledge of Microsoft Office applications
- Keyboarding skills of 60 WPM desired
- Highly organized with the ability to perform multiple tasks efficiently in a fast paced environment
- Ability to work collaboratively with all levels of staff
Work Environment
This is a remote position. Southern California residency is preferred, as the position requires occasional onsite meetings at our office located at 3330 Harbor Blvd, Suite 200, Costa Mesa, California 92626.
How to Apply
Please submit your resume to lanphan@msosocal.com with the subject line "Claims Examiner I Application."
How to Apply
Email your resume and the position title to lanphan@msosocal.com, or call (818) 399-8996. MSO Inc. is an equal opportunity employer.
Costa Mesa, CA 92626
